Search results for: female subjectivity

Authors: Piyaorn Wajanatinapart, Diane R. Lauver

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The number of persons with dementia (PWD) has increased. Informal caregivers are the major providing care. They can have perceived gains and burdens. Caregivers who reported high in perceived gains may report low in burdens and better health. Gaps of caregiving literature were: no report psychometrics in a few studies and unclear definitions of gains; most studies with no theory-guided and conducting in Western countries; not fully described relationships among caregiving variables: motivations, satisfaction with psychological needs, social support, gains, burdens, and physical and psycho-emotional health. Those gaps were filled by assessing psychometric properties of selected measures, providing clearly definitions of gains, using self-determination theory (SDT) to guide the study, and developing the study in Thailand. The study purposes were to evaluate six measures for internal consistency reliability, content validity, and construct validity. This study also examined relationships of caregiving variables: motivations (controlled and autonomous motivations), satisfaction with psychological needs (autonomy, competency, and relatedness), perceived social support, perceived gains, perceived burdens, and physical and psycho-emotional health. This study was a cross-sectional and correlational descriptive design with two convenience samples. Sample 1 was five Thai experts to assess content validity of measures. Sample 2 was 146 Thai caregivers of PWD to assess construct validity, reliability, and relationships among caregiving variables. Experts rated questionnaires and sent them back via e-mail. Caregivers answered questionnaires at clinics of four Thai hospitals. Data analysis was used descriptive statistics and bivariate and multivariate analyses using the composite indicator structural equation model to control measurement errors. For study results, most caregivers were female (82%), middle age (M =51.1, SD =11.9), and daughters (57%). They provided care for 15 hours/day with 4.6 years. The content validity indices of items and scales were .80 or higher for clarity and relevance. Experts suggested item revisions. Cronbach’s alphas were .63 to .93 of ten subscales of four measures and .26 to .57 of three subscales. The gain scale was acceptable for construct validity. With controlling covariates, controlled motivations, the satisfaction with three subscales of psychological needs, and perceived social support had positive relationships with physical and psycho-emotional health. Both satisfaction with autonomy subscale and perceived social support had negative relationship with perceived burdens. The satisfaction with three subscales of psychological needs had positive relationships among them. Physical and psycho-emotional health subscales had positive relationships with each other. Furthermore, perceived burdens had negative relationships with physical and psycho-emotional health. This study was the first use SDT to describe relationships of caregiving variables in Thailand. Caregivers’ characteristics were consistent with literature. Four measures were valid and reliable except two measures. Breadth knowledge about relationships was provided. Interpretation of study results was cautious because of using same sample to evaluate psychometric properties of measures and relationships of caregiving variables. Researchers could use four measures for further caregiving studies. Using a theory would help describe concepts, propositions, and measures used. Researchers may examine the satisfaction with psychological needs as mediators. Future studies to collect data with caregivers in communities are needed.

Keywords: caregivers, caregiving, dementia, measures

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Authors: Natalia C. E. S. Nascimento, Mercia L. Oliveira, Fernando R. A. Lima, Leonardo T. C. do Nascimento, Marina B. Silveira, Brigida G. A. Schirmer, Andrea V. Ferreira, Carlos Malamut, Juliana B. da Silva

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Tissue hypoxia is a common characteristic of solid tumors leading to decreased sensitivity to radiotherapy and chemotherapy. In the clinical context, tumor hypoxia assessment employing the positron emission tomography (PET) tracer ¹⁸F-fluoromisonidazole ([¹⁸F]FMISO) is helpful for physicians for planning and therapy adjusting. The aim of this work was to implement the synthesis of 18F-FMISO in a TRACERlab® MXFDG module and also to establish the quality control procedure. [¹⁸F]FMISO was synthesized at Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN/Brazil) using an automated synthesizer (TRACERlab® MXFDG, GE) adapted for the production of [¹⁸F]FMISO. The FMISO chemical standard was purchased from ABX. 18O- enriched water was acquired from Center of Molecular Research. Reagent kits containing eluent solution, acetonitrile, ethanol, 2.0 M HCl solution, buffer solution, water for injections and [¹⁸F]FMISO precursor (dissolved in 2 ml acetonitrile) were purchased from ABX. The [¹⁸F]FMISO samples were purified by Solid Phase Extraction method. The quality requirements of [¹⁸F]FMISO are established in the European Pharmacopeia. According to that reference, quality control of [¹⁸F]FMISO should include appearance, pH, radionuclidic identity and purity, radiochemical identity and purity, chemical purity, residual solvents, bacterial endotoxins, and sterility. The duration of the synthesis process was 53 min, with radiochemical yield of (37.00 ± 0.01) % and the specific activity was more than 70 GBq/µmol. The syntheses were reproducible and showed satisfactory results. In relation to the quality control analysis, the samples were clear and colorless at pH 6.0. The spectrum emission, measured by using a High-Purity Germanium Detector (HPGe), presented a single peak at 511 keV and the half-life, determined by the decay method in an activimeter, was (111.0 ± 0.5) min, indicating no presence of radioactive contaminants, besides the desirable radionuclide (¹⁸F). The samples showed concentration of tetrabutylammonium (TBA) < 50μg/mL, assessed by visual comparison to TBA standard applied in the same thin layer chromatographic plate. Radiochemical purity was determined by high performance liquid chromatography (HPLC) and the results were 100%. Regarding the residual solvents tested, ethanol and acetonitrile presented concentration lower than 10% and 0.04%, respectively. Healthy female mice were injected via lateral tail vein with [¹⁸F]FMISO, microPET imaging studies (15 min) were performed after 2 h post injection (p.i), and the biodistribution was analyzed in five-time points (30, 60, 90, 120 and 180 min) after injection. Subsequently, organs/tissues were assayed for radioactivity with a gamma counter. All parameters of quality control test were in agreement to quality criteria confirming that [¹⁸F]FMISO was suitable for use in non-clinical and clinical trials, following the legal requirements for the production of new radiopharmaceuticals in Brazil.

Keywords: automatic radiosynthesis, hypoxic tumors, pharmacopeia, positron emitters, quality requirements

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Authors: Sharma Aseem, Dhurat Rachita, Pawar Varsha, Khalse Manisha

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Introduction: Androgenetic alopecia (AGA) is a prevalent condition characterized by progressive hair thinning driven by genetic and androgen-related factors. The current FDA-approved treatments include oral finasteride and topical minoxidil, though many patients seek combination therapies to enhance results. This study aims to evaluate the effectiveness of a combination therapy involving Minoxidil, Finasteride, and Capixyl™ based on feedback from dermatologists. Methodology: A survey, validated by experts, was distributed to 29 leading dermatologists across India (in Tier 1 and 2 cities). The survey examined real-world clinical experiences, focusing on patient outcomes and the overall effectiveness of the mentioned formulation. Results: Among the surveyed dermatologists, 41.4% identified women aged 35-40 as the most frequently diagnosed with female pattern hair loss. The combination therapy with Minoxidil, Finasteride, and Capixyl™ was utilized by 34.5% of dermatologists for over 60 patients per month. The majority highlighted the benefits of this combination therapy, which acts via multiple mechanisms, such as vasodilation and dihydrotestosterone (DHT) receptor blockade, resulting in improved hair regrowth. Additionally, patients demonstrated better clinical outcomes, enhanced compliance, and fewer side effects. Demographically, younger patients, particularly those with AGA for less than 10 years, responded more positively to the treatment. Early intervention led to quicker and more significant results. Overall satisfaction among dermatologists was high, with 86.2% expressing positive feedback on the therapy. In terms of treatment outcomes, 51.7% of dermatologists observed visible results within 4-6 months, while 34.5% noticed a significant reduction in hair fall within 8-12 weeks. Improvements in scalp health were reported by 48.3%, and 51.7% saw an increased hair density within 3-4 months. Despite mild side effects such as scalp irritation, dryness, flaking, and occasional issues like folliculitis, headaches, itching, and redness, patient satisfaction remained high. Dermatologists reported that 93.1% of patients experienced faster and better hair regrowth with Capixyl™ compared to Minoxidil alone. Suggestions for improving the formulation included incorporating peptides like Saw Palmetto and enhancing product packaging to better meet patient needs. Discussion: The combination of Minoxidil, Finasteride, and Capixyl™ yielded positive clinical outcomes, especially in improving hair density, scalp health, and overall patient satisfaction. Dermatologists found that Capixyl™ peptides enhanced the therapeutic effect, promoting hair regrowth and improving compliance. While side effects were generally mild, there were suggestions to further improve the formulation by adding additional peptides like Saw Palmetto. Conclusion: The combination of Minoxidil and Finasteride fortified with Capixyl™ presents a promising therapeutic option for managing AGA. Dermatologists reported significant improvements in hair density, scalp health, and patient satisfaction. With its favorable efficacy and manageable side effects, this formulation proves to be a valuable addition to the treatment landscape for AGA.

Keywords: androgenetic alopecia, combination therapy, minoxidil, finasteride, capixyl

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Authors: Judith Sue Hwa Joo

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Guanyin (Avalokiteśvara in Sanskrit), the Bodhisattva of Mercy and Compassion, is the most widely worshipped Buddhist Divinity in Chinese societies and is also believed by more than half of Asian populations across various countries. The most overwhelming reason for the popularity of Guanyin in Chinese societies is, according to the Lotus Sutra, that Guanyin would apperceive voices of those suffering from immense afflictions and troubles, and liberate them upon crying for his/her holy name with wholeheartedness. Its pervasive social influence has spanned more than two thousand years and is still deeply affecting the lives of most Chinese people. This study aimed to investigate whether Guanyin Worship has evolved and changed in modern Chinese societies across the Taiwan Strait. Taiwan and China, albeit having the same language and culture, have been territorially divided and governed by two different political regimes for over 70 years. It would be scientifically intriguing to unveil any substantial changes in religious behaviors in the context of Guanyin Worship. A comprehensive anonymous questionnaire survey in Chinese communities was conducted from October 2017 to May 2019 across various countries, mostly in China, Taiwan, and Hong Kong areas. Since the religious survey is officially prohibited in China, the study was difficult and could only be exercised by means of snowball sampling. Demographic data (age, sex, education, religious belief) were registered and Guanyin’s salvation functions under various confronting situations were investigated. Psychological dimensions of religious belief in Guanyin were probed in terms of the worship experience, the willingness of veneration, and egoistic or altruistic ideations. A literature review on documented functional attributes was carried out in parallel for comparison analyses with traditional roles. Effective 1123 out of 1139 samples were obtained. Statistical analysis revealed that Guanyin Worship is still commonly practiced and deeply rooted in the hearts of all Chinese people regardless of gender, age, education, and residential area, even though they may not enshrine Guanyin at home nowadays. The conventional roles of Guanyin Bodhisattva are still valid and best satisfy the real interests of lifestyles in modern times. When comparing the traditional Buddhist Sutra and the documented literature, the divine power of modern Guanyin has notably empowered to recover, protect and transform fetal and infant spirits due to the sexual liberation, increased abortion rate, gender awakening and enhanced female autonomy in the reproductive decision. However, the One-Child policy may have critically impacted the trajectory of Guanyin Worship so that people in China prevail over those in Taiwan praying for aborted lives or premature deaths. Furthermore, particularly in Hong Kong and Macao, Guanyin not only serves as the sea guardian for the fishermen but also additional services a new function as the God of Wealth. The divine powers and salvation functions of Guanyin are indeed evolving and expanding to comply with the modern psychosocial, cultural and societal needs. This study sheds light on the modernization process of the two-thousand-year-old Guanyin Worship of contemporary Chinese societies.

Keywords: Buddhism, Guanyin, religious behavior, salvation function

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Authors: Ani Kojoyan

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Linguistic studies have been investigating a connection between gender and linguistic development since 1970s. Scholars claim that gender differences in first and second language learning are socially constructed. Recent studies to language learning and gender reveal that second language acquisition is also a social phenomenon directly influencing one’s gender identity. Those responsible for designing language learning-teaching materials should be encouraged to understand the importance of and address the gender sensitivity accurately in textbooks. Writing or compiling a textbook is not an easy task; it requires strong academic abilities, patience, and experience. For a long period of time Armenia has been involved in the compilation process of a number of foreign language textbooks. However, there have been very few discussions or evaluations of those textbooks which will allow specialists to theorize that practice. The present paper focuses on the analysis of gender sensitivity issues and policy aspects involved in an EFL textbook. For the research the following material has been considered – “A Basic English Grammar: Morphology”, first printed in 2011. The selection of the material is not accidental. First, the mentioned textbook has been widely used in university teaching over years. Secondly, in Armenia “A Basic English Grammar: Morphology” has considered one of the most successful English grammar textbooks in a university teaching environment and served a source-book for other authors to compile and design their textbooks. The present paper aims to find out whether an EFL textbook is gendered in the Armenian teaching environment, and whether the textbook compilers are aware of gendered messages while compiling educational materials. It also aims at investigating students’ attitude toward the gendered messages in those materials. And finally, it also aims at increasing the gender sensitivity among book compilers and educators in various educational settings. For this study qualitative and quantitative research methods of analyses have been applied, the quantitative – in terms of carrying out surveys among students (45 university students, 18-25 age group), and the qualitative one – by discourse analysis of the material and conducting in-depth and semi-structured interviews with the Armenian compilers of the textbook (interviews with 3 authors). The study is based on passive and active observations and teaching experience done in a university classroom environment in 2014-2015, 2015-2016. The findings suggest that the discussed and analyzed teaching materials (145 extracts and examples) include traditional examples of intensive use of language and role-modelling, particularly, men are mostly portrayed as active, progressive, aggressive, whereas women are often depicted as passive and weak. These modeled often serve as a ‘reliable basis’ for reinforcing the traditional roles that have been projected on female and male students. The survey results also show that such materials contribute directly to shaping learners’ social attitudes and expectations around issues of gender. The applied techniques and discussed issues can be generalized and applied to other foreign language textbook compilation processes, since those principles, regardless of a language, are mostly the same.

Keywords: EFL textbooks, gender policy, gender sensitivity, qualitative and quantitative research methods

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Authors: Arup Dutta, Badrul Alam, Sayed M. Wazed, Taslima Newaz, Srobonti Dutta

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Background: In today's world, with modern science and contemporary technology, a lot of diseases may be quickly identified and ruled out, but children's fever of unknown origin (FUO) still presents diagnostic difficulties in clinical settings. Any fever that reaches 38 °C and lasts for more than seven days without a known cause is now classified as a fever of unknown origin (FUO). Despite tremendous progress in the medical sector, fever of unknown origin, or FOU, persists as a major health issue and a major contributor to morbidity and mortality, particularly in children, and its spectrum is sometimes unpredictable. The etiology is influenced by geographic location, age, socioeconomic level, frequency of antibiotic resistance, and genetic vulnerability. Since there are currently no known diagnostic algorithms, doctors are forced to evaluate each patient one at a time with extreme caution. A persistent fever poses difficulties for both the patient and the doctor. This prospective observational study was carried out in a Bangladeshi tertiary care hospital from June 2018 to May 2019 with the goal of identifying the epidemiological patterns of fever of unknown origin in pediatric patients. Methods: It was a hospital-based prospective observational study carried out on 106 children (between 2 months and 12 years) with prolonged fever of >38.0 °C lasting for more than 7 days without a clear source. Children with additional chronic diseases or known immunodeficiency problems were not allowed. Clinical practices that helped determine the definitive etiology were assessed. Initial testing included a complete blood count, a routine urine examination, PBF, a chest X-ray, CRP measurement, blood cultures, serology, and additional pertinent investigations. The analysis focused mostly on the etiological results. The standard program SPSS 21 was used to analyze all of the study data. Findings: A total of 106 patients identified as having FUO were assessed, with over half (57.5%) being female and the majority (40.6%) falling within the 1 to 3-year age range. The study categorized the etiological outcomes into five groups: infections, malignancies, connective tissue conditions, miscellaneous, and undiagnosed. In the group that was being studied, infections were found to be the main cause in 44.3% of cases. Undiagnosed cases came in at 31.1%, cancers at 10.4%, other causes at 8.5%, and connective tissue disorders at 4.7%. Hepato-splenomegaly was seen in people with enteric fever, malaria, acute lymphoid leukemia, lymphoma, and hepatic abscesses, either by itself or in combination with other conditions. About 53% of people who were not diagnosed also had hepato-splenomegaly at the same time. Conclusion: Infections are the primary cause of PUO (pyrexia of unknown origin) in children, with undiagnosed cases being the second most common cause. An incremental approach is beneficial in the process of diagnosing a condition. Non-invasive examinations are used to diagnose infections and connective tissue disorders, while invasive investigations are used to diagnose cancer and other ailments. According to this study, the prevalence of undiagnosed diseases is still remarkable, so extensive historical analysis and physical examinations are necessary in order to provide a precise diagnosis.

Keywords: children, diagnostic challenges, fever of unknown origin, pediatric fever, undiagnosed diseases

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Authors: Patrick Cormier, Cesar Meylan, Matt Jensen, Dana Agar-Newman, Chloe Werle, Ming-Chang Tsai, Marc Klimstra

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Sprint-derived horizontal force-velocity-power (FVP) profiles can be developed with adequate validity and reliability with satellite (GPS/GNSS) systems. However, FVP metrics are sensitive to small nuances in data processing procedures such that minor differences in defining the onset and end of the sprint could result in different FVP metric outcomes. Furthermore, in team-sports, there is a requirement for rapid analysis and feedback of results from multiple athletes, therefore developing standardized and automated methods to improve the speed, efficiency and reliability of this process are warranted. Thus, the purpose of this study was to compare different methods of sprint end detection on the development of FVP profiles from 10Hz GPS/GNSS data through goodness-of-fit and intertrial reliability statistics. Seventeen national team female soccer players participated in the FVP protocol which consisted of 2x40m maximal sprints performed towards the end of a soccer specific warm-up in a training session (1020 hPa, wind = 0, temperature = 30°C) on an open grass field. Each player wore a 10Hz Catapult system unit (Vector S7, Catapult Innovations) inserted in a vest in a pouch between the scapulae. All data were analyzed following common procedures. Variables computed and assessed were the model parameters, estimated maximal sprint speed (MSS) and the acceleration constant τ, in addition to horizontal relative force (F₀), velocity at zero (V₀), and relative mechanical power (Pmax). The onset of the sprints was standardized with an acceleration threshold of 0.1 m/s². The sprint end detection methods were: 1. Time when peak velocity (MSS) was achieved (zero acceleration), 2. Time after peak velocity drops by -0.4 m/s, 3. Time after peak velocity drops by -0.6 m/s, and 4. When the integrated distance from the GPS/GNSS signal achieves 40-m. Goodness-of-fit of each sprint end detection method was determined using the residual sum of squares (RSS) to demonstrate the error of the FVP modeling with the sprint data from the GPS/GNSS system. Inter-trial reliability (from 2 trials) was assessed utilizing intraclass correlation coefficients (ICC). For goodness-of-fit results, the end detection technique that used the time when peak velocity was achieved (zero acceleration) had the lowest RSS values, followed by -0.4 and -0.6 velocity decay, and 40-m end had the highest RSS values. For intertrial reliability, the end of sprint detection techniques that were defined as the time at (method 1) or shortly after (method 2 and 3) when MSS was achieved had very large to near perfect ICC and the time at the 40 m integrated distance (method 4) had large to very large ICCs. Peak velocity was reached at 29.52 ± 4.02-m. Therefore, sport scientists should implement end of sprint detection either when peak velocity is determined or shortly after to improve goodness of fit to achieve reliable between trial FVP profile metrics. Although, more robust processing and modeling procedures should be developed in future research to improve sprint model fitting. This protocol was seamlessly integrated into the usual training which shows promise for sprint monitoring in the field with this technology.

Keywords: automated, biomechanics, team-sports, sprint

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Authors: G. Kontochristopoulos, T. Spiliopoulos, V. Markantoni, E. Platsidaki, A. Kouris, E. Balamoti, C. Bokotas, G. Haidemenos

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Introduction: There is a high patient demand for periorbital rejuvenation since the facial area is often the first to show visible signs of aging. With advancing age, there are sometimes marked changes that occur in the skin, fat, muscle and bone of the periorbital region, resulting to wrinkles and skin laxity. These changes are among the easiest areas to correct using several minimally invasive techniques, which have become increasingly popular over the last decade. Lasers, radiofrequency, botulinum toxin, fat grafting and fillers are available treatments sometimes in combination to traditional blepharoplasty. This study attempts to show the benefits of a minimally invasive approach to periorbital wrinkles and skin laxity that combine microneedling and 10% trichloroacetic acid (TCA) peels. Method: Eleven female patients aged 34-72 enrolled in the study. They all gave informed consent after receiving detailed information regarding the treatment procedure. Exclusion criteria in the study were previous treatment for the same condition in the past six months, pregnancy, allergy or hypersensitivity to the components, infection, inflammation and photosensitivity on the affected region. All patients had diffuse periorbital wrinkles and mild to moderate upper or lower eyelid skin laxity. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% trichloroacetic acid solution to each periorbital area for five minutes. Needling at a 0,25 mm depth was performed in both latelar (x-y) directions. Subsequently, the peeling agent was applied to each periorbital area for five minutes. Patients were subjected to the above combination every two weeks for a series of four treatments. Subsequently they were followed up regularly every month for two months. The effect was photo-documented. A Physician's and a Patient's Global Assessment Scale was used to evaluate the efficacy of the treatment (0-25% indicated poor response, 25%-50% fair, 50%-75% good and 75%-100% excellent response). Safety was assessed by monitoring early and delayed adverse events. Results: At the end of the study, almost all patients demonstrated significant aesthetic improvement. Physicians assessed a fair and a good improvement in 9(81.8% of patients) and 2(18.1% of patients) participants respectively. Patients Global Assessment rated a fair and a good response in 6 (54.5%) and 5 (45.4%) participants respectively. The procedure was well tolerated and all patients were satisfied. Mild discomfort and transient erythema were quite common during or immediately after the procedure, however only temporary. During the monthly follow up, no complications or scars were observed. Conclusions: Microneedling is known as a simple, office–based collagen induction therapy. Low concentration TCA solution applied to the epidermis that has been more permeable by microneedling, can reach the dermis more effectively. In the present study, chemical peels with 10% TCA acted as an adjuvant to microneedling, as it causes controlled skin damage, promoting regeneration and rejuvenation of tissues. This combined therapy improved periorbital fine lines, wrinkles, and overall appearance of the skin. Thus it constitutes an alternative treatment of periorbital skin aging, with encouraging results and minor side-effects.

Keywords: chemical peels, microneedling, periorbital wrinkles, skin laxity

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Authors: Md. Nurul Alom Siddikqe

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The purpose of this intervention was to describe how the marginalized people protect their rights and increase their self-dignity and self-esteem among brothel-based sex workers in 6 cities which are the victim of trafficked who came from different periphery areas Bangladesh. Eventually the sex workers are tortured by the pimp, clients, Msahi (so called guardian of bonded sex workers), Babu (So called husband) highly discriminated, vulnerable and stigmatized due to their occupation, movement, behavior and activities, which has got social disapproval. However, stigma, discrimination and violation of human rights not only bar them to access legal services, education of their kids, health, movement of outside of brothel, deprived of funeral after death, but also make them inaccessible due to their invisibility. Conducted an assessment among brothel-based sex workers setup to know their knowledge on human rights and find out their harassment and violence in their community. Inspired them to think about to be united and also assisted them to formation of self help group (SHG). Developed capacity of the SHG and developed leadership of its members through different trainings like administrative, financial management, public speaking and resource mobilization. Developed strategy to enhance the capacity of SHG so that they can collectively claim their rights and develop strategic partnership and network with the relevant service provider’s for restoring all sorts of rights. Conducted meeting with stakeholder including duty bearers, civil society organizations, media people and local government initiatives. Developed Networking with human rights commission, local elite, religious leaders and form human right watch committees at community level. Organized rally and observed national and international days along with government counterparts. By utilizing the project resources the members of SHG became capable to raise their collective voices against violence, discrimination and stigma as well as protected them from insecurity. The members of SHG have been participating in social program/event the SHG got membership of district level NGO coordination meeting through invitation from Deputy Commissioner, Civil Surgeon and Social welfare office of Government of Bangladesh. The Law Enforcement Agency is ensuring safety and security and the education department of government enrolled their children in primary level education. The Government provided land for grave yard after death for the Muslim sex workers and same for the other religious group. The SHGs are registered with government respective authorities. The SHGs are working with support from different development partners and implementing different projects sometime as consortium leaders. Opportunity created to take the vocational training from the government reputed department. The harassment by the clients reduced remarkably, babu, Mashi and other counterparts recognized the sex workers rights and ensure security with government counterpart access increased in legal, health and education. Indications are that the brothel based sex workers understood about their rights and became capable of ensuring their security through working under the self-help groups meaningfully.

Keywords: brothel, discrimination, harassment, stigma

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Authors: Jarrod Haar, David Brougham

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The present study explores the links between supporting employee well-being and the potential benefits to employee performance. We focus on employee innovative work behaviors (IWBs), which have three stages: (1) development, (2) adoption, and (3) implementation of new ideas and work methods. We explore the role of organizational support focusing on employee well-being via High-Performance Work Systems (HPWS). HPWS are HR practices that are designed to enhance employees’ skills, commitment, and ultimately, productivity. HPWS influence employee performance through building their skills, knowledge, and abilities and there is meta-analytic support for firm-level HPWS influencing firm performance, but less attention towards employee outcomes, especially innovation. We explore HPWS-wellbeing being offered (e.g., EAPs, well-being App, etc.) to capture organizational commitment to employee well-being. Under social exchange theory, workers should reciprocate their firm's offering of HPWS-wellbeing with greater efforts towards IWBs. Further, we explore playful work design as a mediator, which represents employees proactively creating work conditions that foster enjoyment/challenge but don’t require any design change to the job itself. We suggest HPWS-wellbeing can encourage employees to become more playful, and ultimately more innovative. Finally, beyond direct effects, we examine whether these relations are similar by gender and ultimately test a moderated mediation model. Using N=1135 New Zealand employees, we established measures with confirmatory factor analysis (CFA), and all measures had good psychometric properties (α>.80). We controlled for age, tenure, education, and hours worked and analyzed data using the PROCESS macro (version 4.2) specifically model 8 (moderated mediation). We analyzed overall IWB, and then again across the three stages. Overall, we find HPWS-wellbeing is significantly related to overall IWBs and the three stages (development, adoption, and implementation) individually. Similarly, HPWS-wellbeing shapes playful work design and playful work design predicts overall IWBs and the three stages individually. It only partially mediates the effects of HPWS-wellbeing, which retains a significant indirect effect. Moderation effects are supported, with males reporting a more significant effect from HPWS-wellbeing on playful work design but not IWB (or any of the three stages) than females. Females report higher playful work design when HPWS-wellbeing is low, but the effects are reversed when HPWS-wellbeing is high (males higher). Thus, males respond stronger under social exchange theory from HPWS-wellbeing, at least towards expressing playful work design. Finally, evidence of moderated mediation effects is found on overall IWBs and the three stages. Males report a significant indirect effect from HPWS-wellbeing on IWB (through playful work design), while female employees report no significant indirect effect. The benefits of playful work design fully account for their IWBs. The models account for small amounts of variance towards playful work design (12%) but larger for IWBs (26%). The study highlights a gap in the literature on HPWS-wellbeing and provides empirical evidence of their importance towards worker innovation. Further, gendered effects suggest these benefits might not be equal. The findings provide useful insights for organizations around how providing HR practices that support employee well-being are important, although how they work for different genders needs further exploration.

Keywords: human resource practices, wellbeing, innovation, playful work design

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Authors: Jocelyne Uwibambe, Ange Thaina Ndizeye, Dinah Ishimwe, Emmanuel Mugabo Byakagaba

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Background: In low- and middle-income countries (LMICs), the use of modern contraceptive methods among women, including adolescents, is still low despite the desire to avoid pregnancy. In addition, countries have set a minimum age for marriage, which is 21 years for most countries, including Rwanda. The Rwandan culture, to a certain extent, and religion, to a greater extent, however, limit the freedom of young women to use contraceptive services because it is wrongly perceived as an encouragement for premarital sexual intercourse. In the end, what doesn’t change is that denying access to contraceptives to either male or female adolescents does not translate into preventing them from sexual activities, hence leading to an ever-increasing number of unwanted pregnancies, possible STIs, HIV, Human Papilloma Virus, and subsequent unsafe abortion followed by avoidable expensive complications. The purpose of this study is to evaluate the perception of healthcare providers regarding contraceptive use among adolescents. Methodology: This was a qualitative study. Interviews were done with different healthcare providers, including doctors, nurses, midwives, and pharmacists, through focused group discussions and in-depth interviews, then the audio was transcribed, translated and thematic coding was done. Results: This study explored the perceptions of healthcare workers regarding the provision of modern contraception to adolescents in Rwanda. The findings revealed that while healthcare providers had a good understanding of family planning and contraception, they were hesitant to provide contraception to adolescents. Sociocultural beliefs played a significant role in shaping their attitudes, as many healthcare workers believed that providing contraception to adolescents would encourage promiscuous behavior and go against cultural norms. Religious beliefs also influenced their reluctance, with some healthcare providers considering premarital sex and contraception as sinful. Lack of knowledge among parents and adolescents themselves was identified as a contributing factor to unwanted pregnancies, as inaccurate information from peers and social media influenced risky sexual behavior. Conditional policies, such as the requirement for parental consent, further hindered adolescents' access to contraception. The study suggested several solutions, including comprehensive sexual and reproductive health education, involving multiple stakeholders, ensuring easy access to contraception, and involving adolescents in policymaking. Overall, this research highlights the need for addressing sociocultural beliefs, improving healthcare providers' knowledge, and revisiting policies to ensure adolescents' reproductive health rights are met in Rwanda. Conclusion: The study highlights the importance of enhancing healthcare provider training, expanding access to modern contraception, implementing community-based interventions, and strengthening policy and programmatic support for adolescent contraception. Addressing these challenges is crucial for improving the provision of family planning services to adolescents in Rwanda and achieving the Sustainable Development Goals related to sexual and reproductive health. Collaborative efforts involving various stakeholders and organizations can contribute to overcoming these barriers and promoting the well-being of adolescents in Rwanda.

Keywords: adolescent, health care providers, contraception, reproductive health

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Authors: Carlos M. Parra, Matthew Sutherland, Ranjita Poudel

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Reduced mental-bandwidth related to low socioeconomic status (low-SES) might lead to impulsivity and risk-taking behavior, which poses as a major hurdle towards asset building (savings) behavior. Understanding the relationship between risk-related personality metrics as well as laboratory risk behavior and real-life savings behavior can help facilitate the development of effective asset building programs, which are vital for mitigating financial vulnerability and income inequality. As such, this study explored the relationship between personality metrics, laboratory behavior in a risky decision-making task and real-life asset building (savings) behaviors among individuals with low-SES from Miami, Florida (FL). Study participants (12 male, 15 female) included racially and ethnically diverse adults (mean age 41.22 ± 12.65 years), with incomplete higher education (18% had High School Diploma, 30% Associates, and 52% Some College), and low annual income (mean $13,872 ± $8020.43). Participants completed eight self-report surveys and played a widely used risky decision-making paradigm called the Balloon Analogue Risk Task (BART). Specifically, participants played three runs of BART (20 trials in each run; total 60 trials). In addition, asset building behavior data was collected for 24 participants who opened and used savings accounts and completed a 6-month savings program that involved monthly matches, and a final reward for completing the savings program without any interim withdrawals. Each participant’s total savings at the end of this program was the main asset building indicator considered. In addition, a new effective use of average pump bet (EUAPB) indicator was developed to characterize each participant’s ability to place winning bets. This indicator takes the ratio of each participant’s total BART earnings to average pump bet (APB) in all 60 trials. Our findings indicated that EUAPB explained more than a third of the variation in total savings among participants. Moreover, participants who managed to obtain BART earnings of at least 30 cents out of their APB, also tended to exhibit better asset building (savings) behavior. In particular, using this criterion to separate participants into high and low EUAPB groups, the nine participants with high EUAPB (mean BART earnings of 35.64 cents per APB) ended up with higher mean total savings ($255.11), while the 15 participants with low EUAPB (mean BART earnings of 22.50 cents per APB) obtained lower mean total savings ($40.01). All mean differences are statistically significant (2-tailed p  .0001) indicating that the relation between higher EUAPB and higher total savings is robust. Overall, these findings can help refine asset building interventions implemented by policy makers and practitioners interested in reducing financial vulnerability among low-SES population. Specifically, by helping identify individuals who are likely to readily take advantage of savings opportunities (such as matched savings programs) and avoiding the stipulation of unnecessary and expensive financial coaching programs to these individuals. This study was funded by J.P. Morgan Chase (JPMC) and carried out by scientists from Florida International University (FIU) in partnership with Catalyst Miami.

Keywords: balloon analogue risk task (BART), matched savings programs, asset building capability, low-SES participants

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Authors: Fernanda Piculo, Giovana Vesentini, Gabriela Marini, Debora Cristina Damasceno, Angelica Mercia Pascon Barbosa, Marilza Vieira Cunha Rudge

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Introduction: Women with previous gestational diabetes mellitus (GDM) were significantly more likely to have urinary incontinence (UI) and pelvic floor muscle dysfunction compared to non-diabetic women two years after a cesarean section. Additional results demonstrated that induced diabetes causes detrimental effects on pregnant rat urethral muscle. These results indicate the need for exploration of the mechanistic role of a recovery factor in female UI. Chemokine ligand 7 (CCL7) was significantly over expressed in rat serum, urethral and vaginal tissues immediately following induction of stress UI in a rat model simulating birth trauma. CCL7 over expression has shown potency for stimulating targeted stem cell migration and provide a translational link (clinical measurement) which further provide opportunities for treatment. The aim of this study was to investigate the CCL7 levels profile in diabetic pregnant women with urinary incontinence during pregnancy over the first year postpartum. Methods: This study was conducted in the Perinatal Diabetes Research Center of the Botucatu Medical School/UNESP, and was approved by the Research Ethics Committee of the Institution (CAAE: 20639813.0.0000.5411). The diagnosis of GDM was established between 24th and 28th gestational weeks, by the 75 g-OGTT test according to ADA’s criteria. Urinary incontinence was defined according to the International Continence Society and the CCL7 levels was measured by ELISA (R&D Systems, Catalog Number DCC700). Two hundred twelve women were classified into four study groups: normoglycemic continent (NC), normoglycemic incontinent (NI), diabetic continent (DC) and diabetic incontinent (DI). They were evaluated at six-time-points: 12-18, 24-28 and 34-38 gestational weeks, 24-48 hours, 6 weeks and 6-12 months postpartum. Results: At 12-18 weeks, it was possible to consider only two groups, continent and incontinent, because at this early gestational period has not yet been the diagnosis of GDM. The group with GDM and UI (DI group) showed lower levels of CCL7 in all time points during pregnancy and postpartum, compared to normoglycemic groups (NC and NI), indicating that these women have not recovered from child birth induced UI during the 6-12 months postpartum compared to their controls, and that the progression of UI and/or lack of recovery throughout the first postpartum year can be related with lower levels of CCL7. Instead, serum CCL7 was significantly increased in the NC group. Taken together, these findings of overexpression of CCL7 in the NC group and decreased levels in the DI group, could confirm that diabetes delays the recovery from child birth induced UI, and that CCL7 could potentially be used as a serum marker of injury. Conclusion: This study demonstrates lower levels of CCL7 in the DI group during pregnancy and postpartum and suggests that the progression of UI in diabetic women and/or lack of recovery throughout the first postpartum year can be related with low levels of CCL7. This provides a translational potential where CCL7 measurement could be used as a surrogate for injury after delivery. Successful controlled CCL7 mediated stem cell homing to the lower urinary tract could one day introduce the potential for non-operative treatment or prevention of stress urinary incontinence.

Keywords: CCL7, gestational diabetes, pregnancy, urinary incontinence

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Authors: A. Boonpratatong, J. Pantong, S. Kiattisaksophon, W. Senavongse

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In this study, an integrated sensing and modeling system for manual wheelchair propulsion measurement and propulsion efficiency calculation was used to indicate the level of overuse. Seven subjects participated in the measurement. On the level surface, the propulsion efficiencies were not different significantly as the riding speed increased. By contrast, the propulsion efficiencies on the 15-degree incline were restricted to around 0.5. The results are supported by previously reported wheeling resistance and propulsion torque relationships implying margin of the overuse. Upper limb musculoskeletal injuries and syndromes in manual wheelchair riders are common, chronic, and may be caused at different levels by the overuse i.e. repetitive riding on steep incline. The qualitative analysis such as the mechanical effectiveness on manual wheeling to establish the relationship between the riding difficulties, mechanical efforts and propulsion outputs is scarce, possibly due to the challenge of simultaneous measurement of those factors in conventional manual wheelchairs and everyday environments. In this study, the integrated sensing and modeling system were used to measure manual wheelchair propulsion efficiency in conventional manual wheelchairs and everyday environments. The sensing unit is comprised of the contact pressure and inertia sensors which are portable and universal. Four healthy male and three healthy female subjects participated in the measurement on level and 15-degree incline surface. Subjects were asked to perform manual wheelchair ridings with three different self-selected speeds on level surface and only preferred speed on the 15-degree incline. Five trials were performed in each condition. The kinematic data of the subject’s dominant hand and a spoke and the trunk of the wheelchair were collected through the inertia sensors. The compression force applied from the thumb of the dominant hand to the push rim was collected through the contact pressure sensors. The signals from all sensors were recorded synchronously. The subject-selected speeds for slow, preferred and fast riding on level surface and subject-preferred speed on 15-degree incline were recorded. The propulsion efficiency as a ratio between the pushing force in tangential direction to the push rim and the net force as a result of the three-dimensional riding motion were derived by inverse dynamic problem solving in the modeling unit. The intra-subject variability of the riding speed was not different significantly as the self-selected speed increased on the level surface. Since the riding speed on the 15-degree incline was difficult to regulate, the intra-subject variability was not applied. On the level surface, the propulsion efficiencies were not different significantly as the riding speed increased. However, the propulsion efficiencies on the 15-degree incline were restricted to around 0.5 for all subjects on their preferred speed. The results are supported by the previously reported relationship between the wheeling resistance and propulsion torque in which the wheelchair axle torque increased but the muscle activities were not increased when the resistance is high. This implies the margin of dynamic efforts on the relatively high resistance being similar to the margin of the overuse indicated by the restricted propulsion efficiency on the 15-degree incline.

Keywords: contact pressure sensor, inertia sensor, integrating sensing and modeling system, manual wheelchair propulsion efficiency, manual wheelchair propulsion measurement, tangential force, resultant force, three-dimensional riding motion

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Authors: Thulile Ndou

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The purpose of this study was to examine the challenges encountered in the mediation of attracting and recruiting academic expatriates who in turn encounter their own obstacles in adjusting into and settling in their host country, host academic institutions and host communities. The none-existence of literature on attraction, placement and management of academic expatriates in the South African context has been acknowledged. Moreover, Higher Education Institutions in South Africa have voiced concerns relating to delayed and prolonged recruitment and selection processes experienced in the employment process of academic expatriates. Once employed, academic expatriates should be supported and acquainted with the surroundings, the local communities as well as be assisted to establish working relations with colleagues in order to facilitate their adjustment and integration process. Hence, an employer should play a critical role in facilitating the adjustment of academic expatriates. This mixed methods study was located in four Higher Education Institutions based in the KwaZulu-Natal province, in South Africa. The explanatory sequential design approach was deployed in the study. The merits of this approach were chiefly that it employed both the quantitative and qualitative techniques of inquiry. Therefore, the study examined and interrogated its subject from a multiplicity of quantitative and qualitative vantage points, yielding a much more enriched and enriching illumination. Mixing the strengths of both the quantitative and the qualitative techniques delivered much more durable articulation and understanding of the subject. A 5-point Likert scale questionnaire was used to collect quantitative data relating to interaction adjustment, general adjustment and work adjustment from academic expatriates. One hundred and forty two (142) academic expatriates participated in the quantitative study. Qualitative data relating to employment process and support offered to academic expatriates was collected through a structured questionnaire and semi-structured interviews. A total of 48 respondents; including, line managers, human resources practitioners, and academic expatriates participated in the qualitative study. The Independent T-test, ANOVA and Descriptive Statistics were performed to analyse, interpret and make meaning of quantitative data and thematic analysis was used to analyse qualitative data. The qualitative results revealed that academic talent is sourced from outside the borders of the country because of the academic skills shortage in almost all academic disciplines especially in the disciplines associated with Science, Engineering and Accounting. However, delays in work permit application process made it difficult to finalise the recruitment and selection process on time. Furthermore, the quantitative results revealed that academic expatriates experience general and interaction adjustment challenges associated with the use of local language and understanding of local culture. However, female academic expatriates were found to be better adjusted in the two areas as compared to male academic expatriates. Moreover, significant mean differences were found between institutions suggesting that academic expatriates based in rural areas experienced adjustment challenges differently from the academic expatriates based in urban areas. The study gestured to the need for policy revisions in the area of immigration, human resources and academic administration.

Keywords: academic expatriates, recruitment and selection, interaction and general adjustment, work adjustment

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Authors: Jessica J. Gillies

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Human trafficking is a gross violation of human rights and thus invokes a strong response particularly throughout the global academic community. A longstanding tension throughout academic debate remains the question of a relationship between anti-trafficking policy and sex industry policy. In Australia, over the previous decade, many human trafficking investigations have related to the sexual exploitation of female victims, and convictions in Australia to date have often been for trafficking women from Thailand. Sex industry policy in Australia varies between states, providing a rich contextual landscape in which to explore this relationship. The purpose of this study was to deconstruct how meaning is constructed surrounding human trafficking throughout these supposedly related political discourses in Australia. In order to analyse the discursive construction of the problem of human trafficking in relation to sex industry policy, a discursive analysis was conducted. The methodology of the study was informed by a feminist theoretical framework, and included academic sources and grey literature such as organisational reports and policy statements regarding anti-trafficking initiatives. The scope of grey literature was restricted to Australian and Thai government and non-government organisation texts. The chosen methodology facilitated a qualitative exploration of the influence of feminist discourses over political discourse in this arena. The discursive analysis exposed clusters of active feminist debates interacting with sex industry policy within individual states throughout Australia. Additionally, strongly opposed sex industry perspectives were uncovered within these competing feminist frameworks. While the influence these groups may exert over policy differs, the debate constructs a discursive relationship between human trafficking and sex industry policy. This is problematic because anti-trafficking policy is drawn to some extent from this discursive construction, therefore affecting support services for survivors of human trafficking. The discursive analysis further revealed misalignment between government and non-government priorities, Australian government anti-trafficking policy appears to favour criminal justice priorities; whereas non-government settings preference human rights protections. Criminal justice priorities invoke questions of legitimacy, leading to strict eligibility policy for survivors seeking support following exploitation in the Australian sex industry, undermining women’s agency and human rights. In practice, these two main findings demonstrate a construction of policy that has serious outcomes on typical survivors in Australia following a lived experience of human trafficking for the purpose of sexual exploitation. The discourses constructed by conflicting feminist arguments influence political discourses throughout Australia. The application of a feminist theoretical framework to the discursive analysis of the problem of human trafficking is unique to this study. The study has exposed a longstanding and unresolved feminist debate that has filtered throughout anti-trafficking political discourse. This study illuminates the problematic construction of anti-trafficking policy, and the implications in practice on survivor support services. Australia has received international criticism for the focus on criminal justice rather than human rights throughout anti-trafficking policy discourse. The outcome of this study has the potential to inform future language and constructive conversations contributing to knowledge around how policy effects survivors in the post trafficking experience.

Keywords: Australia, discursive analysis, government, human trafficking, non-government, Thailand

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Authors: Sarah Hazelwood, Janice Hay

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Methoxyflurane is an inhaled analgesic administered via a disposable inhaler, which has been used in Australia for 40 years for the management of pain in children & adults. However, there is a lack of data for methoxyflurane as a frontline analgesic medication within the emergency department (ED). This study will investigate the usefulness of methoxyflurane in a private inner-city ED. The study concluded that the inclusion of all key stakeholders in the prescribing, administering & use of this new process led to comprehensive uptake & vastly positive outcomes for consumer & health professionals. Method: A 12-week prospective pilot study was completed utilizing patients presenting to the ED in pain (numeric pain rating score > 4) that fit the requirement of methoxyflurane use (as outlined in the Australian Prescriber information package). Nurses completed a formatted spreadsheet for each interaction where methoxyflurane was used. Patient demographics, day, time, initial numeric pain score, analgesic response time, the reason for use, staff concern (free text), & patient feedback (free text), & discharge time was documented. When clinical concern was raised, the researcher retrieved & reviewed patient notes. Results: 140 methoxyflurane inhalers were used. 60% of patients were 31 years of age & over (n=82) with 16% aged 70+. The gender split; 51% male: 49% female. Trauma-related pain (57%) saw the highest use of administration, with the evening hours (1500-2259) seeing the greatest numbers used (39%). Tuesday, Thursday & Sunday shared the highest daily use throughout the study. A minimum numerical pain score of 4/10 (n=13, 9%), with the ranges of 5 - 7/10 (moderate pain) being given by almost 50% of patients. Only 3 instances of pain scores increased post use of methoxyflurane (all other entries showed pain score < initial rating). Patients & staff noted obvious analgesic response within 3 minutes (n= 96, 81%, of administration). Nurses documented a change in patient vital signs for 4 of the 15 patient-related concerns; the remaining concerns were due to “gagging” on the taste, or “having a coughing episode”; one patient tried to leave the department before the procedure was attended (very euphoric state). Upon review of the staff concerns – no adverse events occurred & return to therapeutic vitals occurred within 10 minutes. Length of stay for patients was compared with similar presentations (such as dislocated shoulder or ankle fracture) & saw an average 40-minute decrease in time to discharge. Methoxyflurane treatment was rated “positively” by > 80% of patients – with remaining feedback related to mild & transient concerns. Staff similarly noted a positive response to methoxyflurane as an analgesic & as an added tool for frontline analgesic purposes. Conclusion: Methoxyflurane should be used on suitable patient presentations requiring immediate, short term pain relief. As a highly portable, non-narcotic avenue to treat pain this study showed obvious therapeutic benefit, positive feedback, & a shorter length of stay in the ED. By partnering with key stake holders, this study determined methoxyflurane use decreased work load, decreased wait time to analgesia, and increased patient satisfaction.

Keywords: analgesia, benefits, emergency, methoxyflurane

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Authors: B. S. Premalatha, Kausalya Sahani

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Background: Glomus jugulare tumors arise within the jugular foramen and are commonly seen in females particularly on the left side. Surgical excision of the tumor may cause lower cranial nerve deficits. Cranial nerve involvement produces hoarseness of voice, slurred speech, and dysphagia along with other physical symptoms, thereby affecting the quality of life of individuals. Though oncological clearance is mainly emphasized on while treating these individuals, little importance is given to their communication, voice and swallowing problems, which play a crucial part in daily functioning. Objective: To examine the functions of voice, speech and swallowing outcomes of the subjects, following excision of glomus jugulare tumor. Methods: Two female subjects aged 56 and 62 years had come with a complaint of change in voice, inability to swallow and reduced clarity of speech following surgery for left glomus jugulare tumor were participants of the study. Their surgical information revealed multiple cranial nerve palsies involving the left facial, left superior and recurrent branches of the vagus nerve, left pharyngeal, left soft palate, left hypoglossal and vestibular nerves. Functional outcomes of voice, speech and swallowing were evaluated by perceptual and objective assessment procedures. Assessment included the examination of oral structures and functions, dysarthria by Frenchey dysarthria assessment, cranial nerve functions and swallowing functions. MDVP and Dr. Speech software were used to evaluate acoustic parameters of voice and quality of voice respectively. Results: The study revealed that both the subjects, subsequent to excision of glomus jugulare tumor, showed a varied picture of affected oral structure and functions, articulation, voice and swallowing functions. The cranial nerve assessment showed impairment of the vagus, hypoglossal, facial and glossopharyngeal nerves. Voice examination indicated vocal cord paralysis associated with breathy quality of voice, weak voluntary cough, reduced pitch and loudness range, and poor respiratory support. Perturbation parameters as jitter, shimmer were affected along with s/z ratio indicative of voice fold pathology. Reduced MPD(Maximum Phonation Duration) of vowels indicated that disturbed coordination between respiratory and laryngeal systems. Hypernasality was found to be a prominent feature which reduced speech intelligibility. Imprecise articulation was seen in both the subjects as the hypoglossal nerve was affected following surgery. Injury to vagus, hypoglossal, gloss pharyngeal and facial nerves disturbed the function of swallowing. All the phases of swallow were affected. Aspiration was observed before and during the swallow, confirming the oropharyngeal dysphagia. All the subsystems were affected as per Frenchey Dysarthria Assessment signifying the diagnosis of flaccid dysarthria. Conclusion: There is an observable communication and swallowing difficulty seen following excision of glomus jugulare tumor. Even with complete resection, extensive rehabilitation may be necessary due to significant lower cranial nerve dysfunction. The finding of the present study stresses the need for involvement of as speech and swallowing therapist for pre-operative counseling and assessment of functional outcomes.

Keywords: functional outcome, glomus jugulare tumor excision, multiple cranial nerve impairment, speech and swallowing

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Authors: Paola Montenegro, Maria de los Angeles Balaguera Villa

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In February 2022 Colombia achieved a historic milestone in ensuring universal access to abortion rights with ruling C-055 of 2022 decriminalising abortion up to 24 weeks of gestation. In the context of this triumph and the expansion of telemedicine services in the wake of the COVID-19 pandemic, this research studied the acceptability of self-care abortion in young people (13 - 28 years) through a telemedicine service and also explored the primary needs that should be the focus of such care. The results shine light on a more comprehensive understanding of opportunities and challenges of teleabortion practices in a context that combines overall higher access to technology and low access to reliable information of safe abortion, stigma, and scarcity especially felt by transnational migrants, racialised people, trans men and non-binary people. Through a mixed methods approach, this study collected 5.736 responses to a virtual survey disseminated nationwide in Colombia and 47 in-person interviews (24 of them with people who were assigned female at birth and 21 with local key stakeholders in the abortion ecosystem). Quantitative data was analyzed using Stata SE Version 16.0 and qualitative analysis was completed through NVivo using thematic analysis. Key findings of the research suggest that self-care abortion is practice with growing acceptability among young people, but important adjustments must be made to meet quality of care expectations of users. Elements like quick responses from providers, lower costs, and accessible information were defined by users as decisive factors to choose over the abortion service provider. In general, the narratives in participants about quality care were centred on the promotion of autonomy and the provision of accompaniment and care practices, also perceived as transformative and currently absent of most health care services. The most staggering findings from the investigation are related to current barriers faced by young people in abortion contexts even when the legal barriers have: high rates of scepticism and distrust associated with pitfalls of telehealth and structural challenges associated with lacking communications infrastructure, among a few of them. Other important barriers to safe self-care abortion identified by participants surfaced like lack of privacy and confidentiality (especially in rural areas of the country), difficulties accessing reliable information, high costs of procedures and expenses related to travel costs or having to cease economic activities, waiting times, and stigma are among the primary barriers to abortion identified by participants. Especially in a scenario marked by unprecedented social, political and economic disruptions due to the COVID-19 pandemic, the commitment to design better care services that can be adapted to the identities, experiences, social contexts and possibilities of the user population is more necessary than ever. In this sense, the possibility of expanding access to services through telemedicine brings us closer to the opportunity to rethink the role of health care models in transforming the role of individuals and communities to make autonomous, safe and informed decisions about their own health and well-being.

Keywords: contraception, family planning, premarital fertility, unplanned pregnancy

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Authors: Marie-Helena Docherty, Sion Edryd Williams

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The prevalence of diabetes mellitus is increasing worldwide. In Sub-Saharan Africa, type 2 diabetes represents over 90% of all types of diabetes with the number of diabetic patients expected to rise. This represents a huge economic burden in an area already contending with high rates of other significant diseases, including the highest worldwide prevalence of HIV. Diabetic complications considerably impact on morbidity and mortality. The epidemiological data for the region quotes high rates of retinopathy (7-63%), neuropathy (27-66%) and microalbuminuria (10-83%). It is therefore imperative that diabetic screening programmes are established. It is recognised that in many parts of the developing world the implementation and management of such programmes is limited by a lack of available resources. The International Diabetes Federation produced guidelines in 2012 taking these limitations into account suggesting that all diabetic patients should have access to basic screening. These guidelines are consistent with the national diabetic guidelines produced by the Lesotho Medical Council. However, diabetic care in Lesotho is delivered at the local level, with variable levels of quality. A cross sectional study was performed in the outpatient department of Maluti Hospital in Mapoteng, Lesotho, a busy rural hospital in the Berea district. Demographic data on gender, age and modality of treatment were collected over a six-week time period. Information regarding 3 basic screening parameters was obtained. These parameters included eye screening (defined as a documented ophthalmology review within the last 12 months), foot screening (defined as a documented foot health assessment by any health care professional within the last 12 months) and secondary prevention (defined as a documented blood pressure and lipid profile reading within the last 12 months). These parameters were selected on the basis of the absolute minimum level of resources in Maluti Hospital. Renal screening was excluded, as the hospital does not have access to reliable renal profile checks or urinalysis. There is however a fully functioning on-site ophthalmology department run by a senior ophthalmologist with the ability to provide retinal photography, retinal surgery and photocoagulation therapy. Data was collected on 183 type 2 diabetics. 112 patients were male and 71 were female. The average age was 43 years. 4 patients were diet controlled, 140 patients were on oral hypoglycaemic agents (metformin and/or glibenclamide), and 39 patients were on a combination of insulin and oral hypoglycaemics. In the preceding 12 months, 5 patients had undergone eye screening (3%), 24 patients had undergone foot screening (13%), and 31 patients had lipid profile testing (17%). All patients had a documented blood pressure reading (100%). Our results show that screening is poorly performed in the basic indicators suggested by the IDF and the Lesotho Medical Council. On the basis of these results, a screening programme was developed using the mnemonic SaFE; secondary prevention, foot and eye care. This is simple, memorable and transferable between healthcare professionals. In the future, the expectation would be to expand upon this current programme to include renal screening, and to further develop screening pertaining to secondary prevention.

Keywords: Africa, complications, rural, screening

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Authors: Fabio Rodriguez Sanchez, Josef Bruers, Iciar Arteagoitia, Carlos Rodriguez Andres

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Background: Oral implants are a routine treatment to replace lost teeth. Although they have a high rate of success, implant failures do occur. Perioperative antibiotics have been suggested to prevent postoperative infections and dental implant failures, but they remain a controversial treatment among healthy patients. The objective of this study was to determine whether antibiotic prophylaxis is a common treatment in the Netherlands among general dentists, maxillofacial-surgeons, periodontists and implantologists in conjunction with oral implant surgery among healthy patients and to assess the nature of antibiotics prescriptions in order to evaluate whether any consensus has been reached and the current recommendations are being followed. Methodology: Observational cross-sectional study based on a web-survey reported according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. A validated questionnaire, developed by Deeb et al. (2015), was translated and slightly adjusted to circumstances in the Netherlands. It was used with the explicit permission of the authors. This questionnaire contained both close-ended and some open-ended questions in relation to the following topics: demographics, qualification, antibiotic type, prescription-duration and dosage. An email was sent February 2018 to a sample of 600 general dentists and all 302 oral implantologists, periodontists and maxillofacial surgeons who were recognized by the Dutch Association of Oral Implantology (NVOI) as oral health care providers placing oral implants. The email included a brief introduction about the study objectives and a link to the web questionnaire, which could be filled in anonymously. Overall, 902 questionnaires were sent. However, 29 questionnaires were not correctly received due to an incorrect email address. So a total number of 873 professionals were reached. Collected data were analyzed using SPSS (IBM Corp., released 2012, Armonk, NY). Results: The questionnaire was sent back by a total number of 218 participants (response rate=24.2%), 45 female (20.8%) and 171 male (79.2%). Two respondents were excluded from the study group because they were not currently working as oral health providers. Overall 151 (69.9%) placed oral implants on regular basis. Approximately 79 (52.7%) of these participants prescribed antibiotics only in determined situations, 66 (44.0%) prescribed antibiotics always and 5 dentists (3.3%) did not prescribe antibiotics at all when placing oral implants. Overall, 83 participants who prescribed antibiotics, did so both pre- and postoperatively (58.5%), 12 exclusively postoperative (8.5%), and 47 followed an exclusive preoperative regime (33.1%). A single dose of 2,000 mg amoxicillin orally 1-hour prior treatment was the most prescribed preoperative regimen. The most frequent prescribed postoperative regimen was 500 mg amoxicillin three times daily for 7 days after surgery. On average, oral health professionals prescribed 6,923 mg antibiotics in conjunction with oral implant surgery, varying from 500 to 14,600 mg. Conclusions: Antibiotic prophylaxis in conjunction with oral implant surgery is prescribed in the Netherlands on a rather large scale. Dutch professionals might prescribe antibiotics more cautiously than in other countries and there seems to be a lower range on the different antibiotic types and regimens being prescribed. Anyway, recommendations based on last-published evidence are frequently not being followed.

Keywords: clinical decision making, infection control, antibiotic prophylaxis, dental implants

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Authors: Frederick W. Gooding, Jr., Mark Beeman

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Nearly a century ago, the groundbreaking 1915 film ‘The Birth of a Nation’ popularized the way Hollywood made movies with its avant-garde, feature-length style. The movie's subjugating and demeaning depictions of African American women (and men) reflected popular racist beliefs held during the time of slavery and the early Jim Crow era. Although much has changed concerning race relations in the past century, American sociologist Patricia Hill Collins theorizes that the disparaging images of African American women originating in the era of plantation slavery are adaptable and endure as controlling images today. In this context, a comparative analysis of the successful contemporary film, ‘Bringing Down the House’ starring Queen Latifah is relevant as this 2004 film was designed to purposely defy and ridicule classic stereotypes of African American women. However, the film is still tied to the controlling images from the past, although in a modern hybrid form. Scholars of race and film have noted that the pervasive filmic imagery of the African American woman as the loyal mammy stereotype faded from the screen in the post-civil rights era in favor of more sexualized characters (i.e., the Jezebel trope). Analyzing scenes and dialogue through the lens of sociological and critical race theory, the troubling persistence of African American controlling images in film stubbornly emerge in a movie like ‘Bringing Down the House.’ Thus, these controlling images, like racism itself, can adapt to new social and economic conditions. Although the classic controlling images appeared in the first feature length film focusing on race relations a century ago, ‘The Birth of a Nation,’ this black and white rendition of the mammy figure was later updated in 1939 with the classic hit, ‘Gone with the Wind’ in living color. These popular controlling images have loomed quite large in the minds of international audiences, as ‘Gone with the Wind’ is still shown in American theaters currently, and experts at the British Film Institute in 2004 rated ‘Gone with the Wind’ as the number one movie of all time in UK movie history based upon the total number of actual viewings. Critical analysis of character patterns demonstrate that images that appear superficially benign contribute to a broader and quite persistent pattern of marginalization within the aggregate. This approach allows experts and viewers alike to detect more subtle and sophisticated strands of racial discrimination that are ‘hidden in plain sight’ despite numerous changes in the Hollywood industry that appear to be more voluminous and diverse than three or four decades ago. In contrast to white characters, non-white or minority characters are likely to be subtly compromised or marginalized relative to white characters if and when seen within mainstream movies, rather than be subjected to obvious and offensive racist tropes. The hybrid form of both the older Jezebel and Mammy stereotypes exhibited by lead actress Queen Latifah in ‘Bringing Down the House’ represents a more suave and sophisticated merging of past imagery ideas deemed problematic in the past as well as the present.

Keywords: African Americans, Hollywood film, hybrid, stereotypes

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Authors: Pedro Felgueiras, Ana Miguel, Nélson Almeida, Raquel Silva

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Objective: Through the study of a clinical case of delusional somatic disorder secondary to phantogeusia, we aim to highlight the importance of considering psychosomatic conditions in differential diagnosis, as well as to emphasize the complexity of its comprehension, treatment, and respective impact on patients’ functioning. Methods: Bearing this in mind, we conducted a critical analysis of a case series based on patient observations, clinical data, and complementary diagnostic methods, as well as a non-systematic review of the literature on the subject. Results: A 61-year-old female patient with no history of psychiatric conditions. Family psychiatric history of mood disorder (depression), with psychotic features found in her mother. Medical history of many comorbidities affecting different organ systems (endocrine, gastrointestinal, genitourinary, ophthalmological). Documented neuroticism traits of personality. The patient’s family described a persistent concern about several physical symptoms across her life, with a continuous effort to obtain explanations about any sensation out of her normal perception. Since being subjected to endoscopy in 2018, she started complaints of persistent phantogeusia (acid taste) and developed excessive thoughts, feelings, and behaviors associated with this somatic symptom. The patient was evaluated by several medical specialties, and an extensive panel of medical exams was carried out, excluding any disease. Besides all the investigation and with no evidence of disease signs, acute anxiety, time, and energy dispended to this symptom culminated in severe psychosocial impairment. The patient was admitted to a psychiatric ward for investigation and treatment of this clinical picture, leading to the diagnosis of the delusional somatic disorder. In order to exclude the acute organic etiology of this psychotic disorder, an analytic panel was carried out with no abnormal results. In the context of a psychotic clinical picture, a CT scan was performed, which revealed a right cortical vascular lesion. Neuropsychological evaluation was made, with the description of cognitive functioning being globally normative. During treatment with an antipsychotic (pimozide), a complete remission of the somatic delusion was associated with the disappearance of gustative perception disturbance. In follow-up, a relapse of gustative sensation was documented, and her thoughts and speech were dominated by concerns about multiple somatic symptoms. Conclusion: In terms of abnormal bodily sensations, the oral cavity is one of the frequent sites of delusional disorder. Patients with these gustatory perception distortions complain about unusual sensations without corresponding abnormal findings in the oral area. Its pathophysiology has not been fully elucidated yet. In terms of its comprehensive psychopathology, this case was hypothesized as a paranoid development of a delusional somatic disorder triggered by a post-invasive procedure phantogeusia (which is described as a possible side effect of an endoscopy) in a patient with an anankastic personality. This case presents interesting psychopathology, reinforcing the complexity of psychosomatic disorders in terms of their etiopathogenesis, clinical treatment, and long-term prognosis.

Keywords: psychosomatics, delusional somatic disorder, phantogeusia, paranoid development

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Authors: Shlomit Paz, Meir Broza

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Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period and produces an enterotoxin that causes copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with poor treatment of sewage and drinking water. Cholera remains a global threat and is one of the key indicators of social development. An estimated 3-5 million cases and over 100,000 deaths occur each year around the world. The relevance of climatic events as causative factors for cholera epidemics is well known. However, the examination of the involvement of winds in intra-continental disease distribution is new. The study explore the hypothesis that the spreading of cholera epidemics may be related to the dominant wind direction over land by presenting the influence of the wind direction on windborn dissemination by flying insects, which may serve as vectors. Chironomids ("non-biting midges“) exist in the majority of freshwater aquatic habitats, especially in estuarine and organic-rich water bodies typical to Vibrio cholerae. Chironomid adults emerge into the air for mating and dispersion. They are highly mobile, huge in number and found frequently in the air at various elevations. The huge number of chironomid egg masses attached to hard substrate on the water surface, serve as a reservoir for the free-living Vibrio bacteria. Both male and female, while emerging from the water, may carry the cholera bacteria. In experimental simulation, it was demonstrated that the cholera-bearing adult midges are carried by the wind, and transmit the bacteria from one body of water to another. In our previous study, the geographic diffusions of three cholera outbreaks were examined through their linkage with the wind direction: a) the progress of Vibrio cholerae O1 biotype El Tor in Africa during 1970–1971 and b) again in 2005–2006; and c) the rapid spread of Vibrio cholerae O139 over India during 1992–1993. Using data and map of cholera dissemination (WHO database) and mean monthly SLP and geopotential data (NOAA NCEP-NCAR database), analysis of air pressure data at sea level and at several altitudes over Africa, India and Bangladesh show a correspondence between the dominant wind direction and the intra-continental spread of cholera. The results support the hypothesis that aeroplankton (the tiny life forms that float in the air and that may be caught and carried upward by the wind, landing far from their origin) carry the cholera bacteria from one body of water to an adjacent one. In addition to these findings, the current follow-up study will present new results regarding the possible involvement of winds in the spreading of cholera in recent outbreaks (2010-2013). The findings may improve the understanding of how climatic factors are involved in the rapid distribution of new strains throughout a vast continental area. Awareness of the aerial transfer of Vibrio cholerae may assist health authorities by improving the prediction of the disease’s geographic dissemination.

Keywords: cholera, Vibrio cholerae, wind direction, Vibrio cholerae dissemination

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Authors: Tatiana Butkova, Nikolai Kibrik, Kristina Malsagova, Alexander Izotov, Alexander Stepanov, Anna Kaysheva

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Relevance. The genetic risk of developing schizophrenia is determined by two factors: single nucleotide polymorphisms and gene copy number variations. The search for serological markers for early diagnosis of schizophrenia is driven by the fact that the first five years of the disease are accompanied by significant biological, psychological, and social changes. It is during this period that pathological processes are most amenable to correction. The aim of this study was to analyze single nucleotide polymorphisms (SNPs) that are hypothesized to potentially influence the onset and development of the endogenous process. Materials and Methods It was analyzed 73 single nucleotide polymorphism variants. The study included 48 patients undergoing inpatient treatment at "Psychiatric Clinical Hospital No. 1" in Moscow, comprising 23 females and 25 males. Inclusion criteria: - Patients aged 18 and above. - Diagnosis according to ICD-10: F20.0, F20.2, F20.8, F21.8, F25.1, F25.2. - Voluntary informed consent from patients. Exclusion criteria included: - The presence of concurrent somatic or neurological pathology, neuroinfections, epilepsy, organic central nervous system damage of any etiology, and regular use of medication. - Substance abuse and alcohol dependence. - Women who were pregnant or breastfeeding. Clinical and psychopathological assessment was complemented by psychometric evaluation using the PANSS scale at the beginning and end of treatment. The duration of observation during therapy was 4-6 weeks. Total DNA extraction was performed using QIAamp DNA. Blood samples were processed on Illumina HiScan and genotyped for 652,297 markers on the Infinium Global Chips Screening Array-24v2.0 using the IMPUTE2 program with parameters Ne=20,000 and k=90. Additional filtration was performed based on INFO>0.5 and genotype probability>0.5. Quality control of the obtained DNA was conducted using agarose gel electrophoresis, with each tested sample having a volume of 100 µL. Results. It was observed that several SNPs exhibited gender dependence. We identified groups of single nucleotide polymorphisms with a membership of 80% or more in either the female or male gender. These SNPs included rs2661319, rs2842030, rs4606, rs11868035, rs518147, rs5993883, and rs6269.Another noteworthy finding was the limited combination of SNPs sufficient to manifest clinical symptoms leading to hospitalization. Among all 48 patients, each of whom was analyzed for deviations in 73 SNPs, it was discovered that the combination of involved SNPs in the manifestation of pronounced clinical symptoms of schizophrenia was 19±3 out of 73 possible. In study, the frequency of occurrence of single nucleotide polymorphisms also varied. The most frequently observed SNPs were rs4849127 (in 90% of cases), rs1150226 (86%), rs1414334 (75%), rs10170310 (73%), rs2857657, and rs4436578 (71%). Conclusion. Thus, the results of this study provide additional evidence that these genes may be associated with the development of schizophrenia spectrum disorders. However, it's impossible cannot rule out the hypothesis that these polymorphisms may be in linkage disequilibrium with other functionally significant polymorphisms that may actually be involved in schizophrenia spectrum disorders. It has been shown that missense SNPs by themselves are likely not causative of the disease but are in strong linkage disequilibrium with non-functional SNPs that may indeed contribute to disease predisposition.

Keywords: gene polymorphisms, genotyping, single nucleotide polymorphisms, schizophrenia.

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Authors: Ponchang Apollos Wuyep, Alice Njolke Mafe, Longchi Satkat Zacheaus, Dogun Ojochogu, Dabot Ayuba Yakubu

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Fungi causes huge losses when infections occur both in plants and animals. Synthetic Antifungal drugs are mostly very expensive and highly cytotoxic when taken. This study was aimed at determining the in vitro and in vivo antifungal activities of the leaves and stem extracts of Terminalia mantaly (Umbrella tree)H. Perrier on Aspergillus species in a bid to identify potential sources of cheap starting materials for the synthesis of new drugs to address the growing antimicrobial resistance. T. mantaly leave and stem powdered plant was extracted by fractionation using the method of solvent partition co-efficient in their graded form in the order n-hexane, Ethyl acetate, methanol and distilled water and phytochemical screening of each fraction revealed the presence of alkaloids, saponins, Tannins, flavonoids, carbohydrates, steroids, anthraquinones, cardiac glycosides and terpenoids in varying degrees. The Agar well diffusion technique was used to screen for antifungal activity of the fractions on clinical isolates of Aspergillus species (Aspergillus flavus and Aspergillus fumigatus). Minimum inhibitory concentration (MIC50) of the most active extracts was determined by the broth dilution method. The fractions test indicated a high antifungal activity with zones of inhibition ranging from 6 to 26 mm and 8 to 30mm (leave fractions) and 10mm to 34mm and 14mm to36mm (stem fractions) on A. flavus and A. fumigatus respectively. All the fractions indicated antifungal activity in a dose response relationship at concentrations of 62.5mg/ml, 125mg/ml, 250mg/ml and 500mg/ml. Better antifungal efficacy was shown by the Ethyl acetate, Hexane and Methanol fractions in the in vitro as the most potent fraction with MIC ranging from 62.5 to 125mg/ml. There was no statistically significant difference (P>0.05) in the potency of the Eight fractions from leave and stem (Hexane, Ethyl acetate, methanol and distilled water, antifungal (fluconazole), which served as positive control and 10% DMSO(Dimethyl Sulfoxide)which served as negative control. In the in vivo investigations, the ingestion technique was used for the infectious studies Female Drosophilla melanogaster(UAS-Diptericin)normal flies(positive control),infected and not treated flies (negative control) and infected flies with A. fumigatus and placed on normal diet, diet containing fractions(MSM and HSM each at concentrations of 10mg/ml 20mg/ml, 30mg/ml, 40mg/ml, 50mg/ml, 60mg/ml, 70mg/ml, 80mg/ml, 90mg/ml and 100mg/ml), diet containing control drugs(fluconazole as positive control)and infected flies on normal diet(negative control), the flies were observed for fifteen(15) days. Then the total mortality of flies was recorded each day. The results of the study reveals that the flies were susceptible to infection with A. fumigatus and responded to treatment with more effectiveness at 50mg/ml, 60mg/ml and 70mg/ml for both the Methanol and Hexane stem fractions. Therefore, the Methanol and Hexane stem fractions of T. mantaly contain therapeutically useful compounds, justifying the traditional use of this plant for the treatment of fungal infections.

Keywords: Terminalia mantaly, Aspergillus fumigatus, cytotoxic, Drosophila melanogaster, antifungal

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Authors: Aileen O'loughlin

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‘Is Everybody Going WeLL?’ (IEGW?) is a 33-hour classroom-based initiative created to a) explore values and how they impact on well-being, b) encourage adolescents to connect with their community, and c) provide them with the education to encourage and maintain a lifetime love of physical activity (PA) to ensure beneficial effects on their personal well-being. This initiative is also aimed at achieving sustainable education and aligning with the United Nation’s Sustainable Development Goals numbers 3 and 4. The classroom is a unique setting in which adolescents’ PA participation can be positively influenced through fun PA policies and initiatives. The primary purpose of this research is to evaluate a range of psychosocial and PA outcomes following the 33-hour education programme. This research examined the impact of a PA and well-being programme consisting of either a 60minute or 80minute class, depending on the timetable structure of the school, delivered once a week. Participant outcomes were measured using validated questionnaires regarding Self-esteem, Mental Health Literacy (MHL) and Daily Physical Activity Participation. These questionnaires were administered at three separate time points; baseline, mid-intervention, and post intervention. Semi-structured interviews with participating teachers regarding adherence and participants’ attitudes were completed post-intervention. These teachers were randomly selected for interview. This perspective analytical cohort study included 235 post-primary school students between 11-13 years of age (100 boys and 135 girls) from five public Irish post-primary schools. Three schools received the intervention only; a 33hour interactive well-being learning unit, one school formed a control group and one school had participants in both the intervention and control group. Participating schools were a convenience sample. Data presented outlines baseline data collected pre-participation (0 hours completed). N = 18 junior certificate students returned all three questionnaires fully completed for a 56.3% return rate from 1 school, Intervention School #3. 94.4% (n = 17) of participants enjoy taking part in some form of PA, however only 5.5% (n = 1) of the participants took part in PA every day of the previous 7 days and only 5.5% (n = 1) of those surveyed participated in PA every day during a normal week. 55% (n = 11) had a low level of self-esteem, 50% (n = 9) fall within the normal range of self-esteem, and n = 0 surveyed demonstrated a high level of self-esteem. Female participants’ Mean score was higher than their male counterparts when MHL was compared. Correlation analyses revealed a small association between Self-esteem and Happiness (r = 0.549). Positive correlations were also revealed between MHL and Happiness, MHL and Self-esteem and Self-esteem and 60+ minutes of PA completed daily. IEGW? is a classroom-based with simple methods easy to implement, replicate and financially viable to both public and private schools. It’s unique dataset will allow for the evaluation of a societal approach to the psycho-social well-being and PA participation levels of adolescents. This research is a work in progress and future work is required to learn how to best support the implementation of ‘Is Everybody Going WeLL?’ as part of the school curriculum.

Keywords: education, life-long learning, physical activity, psychosocial well-being

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Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

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Authors: Jayden R. Hunter, Brett A. Gordon, Stephen R. Bird, Amanda C. Benson

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The World Health Organisation recognises the workplace as an important setting for exercise promotion, with potential benefits including improved employee health and fitness, and reduced worker absenteeism and presenteeism. Despite these potential benefits to both employee and employer, there is a lack of evidence supporting the long-term effectiveness of workplace exercise programs. There is, therefore, a need for better-informed programs that cater to employee exercise preferences. Specifically, workplace exercise programs should address any time, motivation, internal and external barriers to participation reported by sub-groups of employees. This study sought to compare exercise participation to perceived barriers and facilitators to workplace exercise engagement of university employees. This information is needed to design and implement wider-reaching programs aiming to maximise long-term employee exercise adherence and subsequent health, fitness and productivity benefits. An online survey was advertised at an Australian university with the potential to reach 3,104 full-time employees. Along with exercise participation (International physical activity questionnaire) and behaviour (stage of behaviour change in relation to physical activity questionnaire), perceived barriers (corporate exercise barriers scale) and facilitators to workplace exercise participation were identified. The survey response rate was 8.1% (252 full-time employees; 95% white-collar; 60% female; 79.4% aged 30–59 years; 57% professional and 38% academic). Most employees reported meeting (43.7%) or exceeding (42.9%) exercise guidelines over the previous week (i.e. ⩾30 min of moderate-intensity exercise on most days or ⩾ 25 min of vigorous-intensity exercise on at least three days per week). Reported exercise behaviour over the previous six months showed that 64.7% of employees were in maintenance, 8.3% were in action, 10.9% were in preparation, 12.4% were in contemplation, and 3.8% were in the pre-contemplation stage of change. Perceived barriers towards workplace exercise participation were significantly higher in employees not attaining weekly exercise guidelines compared to employees meeting or exceeding guidelines, including a lack of time or reduced motivation (p < 0.001; partial eta squared = 0.24 (large effect)), exercise attitude (p < 0.05; partial eta squared = 0.04 (small effect)), internal (p < 0.01; partial eta squared = 0.10 (moderate effect)) and external (p < 0.01; partial eta squared = 0.06 (moderate effect)) barriers. The most frequently reported exercise facilitators were personal training (particularly for insufficiently active employees; 33%) and group exercise classes (20%). The most frequently cited preferred modes of exercise were walking (70%), swimming (50%), gym (48%), and cycling (45%). In conclusion, providing additional means of support such as individualised gym, swimming and cycling programs with personal supervision and guidance may be particularly useful for employees not meeting recommended moderate-vigorous volumes of exercise, to help overcome reported exercise barriers in order to improve participation, health, and fitness. While individual biopsychosocial factors should be considered when making recommendations for interventions, the specific barriers and facilitators to workplace exercise participation identified by this study can inform the development of workplace exercise programs aiming to broaden employee engagement and promote greater ongoing exercise adherence. This is especially important for the uptake of less active employees who perceive greater barriers to workplace exercise participation than their more active colleagues.

Keywords: exercise barriers, exercise facilitators, physical activity, workplace health

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Authors: Abdullah Nurus Salam Khan, Farhana Karim, Mohiuddin Ahsanul Kabir Chowdhury, S. Masum Billah, Nabila Zaka, Alexander Manu, Shams El Arifeen

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Globally, pre-eclampsia (PE) and ante-partum haemorrhage (APH) are two major causes of maternal mortality. Prompt identification and management of these conditions depend on competency of the birth attendants. Since these conditions are infrequent to be observed, clinical vignette based assessment could identify the extent of health worker’s competence in managing emergency obstetric care (EmOC). During June-August 2016, competence of 39 medical officers (MO) and 95 nurses working in obstetric ward of 15 government health facilities (3 district hospital, 12 sub-district hospital) was measured using clinical vignettes on PE and APH. The vignettes resulted in three outcome measures: total vignette scores, scores for diagnosis component, and scores for management component. T-test was conducted to compare mean vignette scores and linear regression was conducted to measure the strength and association of vignette scores with different cadres of health workers, facility’s readiness for EmOC and average annual utilization of normal deliveries after adjusting for type of health facility, health workers’ work experience, training status on managing maternal complication. For each of the seven component of EmOC items (administration of injectable antibiotics, oxytocic and anticonvulsant; manual removal of retained placenta, retained products of conception; blood transfusion and caesarean delivery), if any was practised in the facility within last 6 months, a point was added and cumulative EmOC readiness score (range: 0-7) was generated for each facility. The yearly utilization of delivery cases were identified by taking the average of all normal deliveries conducted during three years (2013-2015) preceding the survey. About 31% of MO and all nurses were female. Mean ( ± sd) age of the nurses were higher than the MO (40.0 ± 6.9 vs. 32.2 ± 6.1 years) and also longer mean( ± sd) working experience (8.9 ± 7.9 vs. 1.9 ± 3.9 years). About 80% health workers received any training on managing maternal complication, however, only 7% received any refresher’s training within last 12 months. The overall vignette score was 8.8 (range: 0-19), which was significantly higher among MO than nurses (10.7 vs. 8.1, p < 0.001) and the score was not associated with health facility types, training status and years of experience of the providers. Vignette score for management component (range: 0-9) increased with higher annual average number of deliveries in their respective working facility (adjusted β-coefficient 0.16, CI 0.03-0.28, p=0.01) and increased with each unit increase in EmOC readiness score (adjusted β-coefficient 0.44, CI 0.04-0.8, p=0.03). The diagnosis component of vignette score was not associated with any of the factors except it was higher among the MO than the nurses (adjusted β-coefficient 1.2, CI 0.13-2.18, p=0.03). Lack of competence in diagnosing and managing obstetric complication by the nurses than the MO is of concern especially when majority of normal deliveries are conducted by the nurses. Better EmOC preparedness of the facility and higher utilization of normal deliveries resulted in higher vignette score for the management component; implying the impact of experiential learning through higher case management. Focus should be given on improving the facility readiness for EmOC and providing the health workers periodic refresher’s training to make them more competent in managing obstetric cases.

Keywords: Bangladesh, emergency obstetric care, clinical vignette, competence of health workers

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